Title Page

  • Site conducted

  • Conducted on

  • Prepared by

General/Sales Floor

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 25. Are Fire Extinguishers inspected monthly and pathway clear of obstruction?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Front End

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 29. Are shopping carts missing child restraints (Seat belts)?

  • 30. Do Motorized Handicap Carts have damaged electrical charging cable (cracked, frayed or missing ground pin)?

  • 31. Any Shopping carts with child seats have missing or broken safety restraint systems?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • 33. Are cashiers using “sweep motions” … using hand scanners for heavy, bulky items?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Grocery Department

  • 1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?

  • 3. Are price molding strips bent and protruding out with sharp edges (may cut or scratch patrons or workers)?

  • 4. Are warehouse storage shelves/racks missing the minimum of two cross member supports?

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 6. Any ice buildup on freezer doors, entrances, floors or walls?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 12. Are compress gas cylinders secured to prevent them from falling?

  • 13. Are moisture proof globes/covers in freezers either missing or broken?

  • 14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?

  • 15. Are trailers using wheel chokes or restraint systems during loading or offloading by forklifts/PIT?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 19. Are forklifts parked on inclines?

  • 20. Are forklifts/electric pallet jacks inspected before use?

  • 21. Do electric roll up/down doors have operative automatic emergency stop?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Meat Department

  • 1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?

  • 2. Are electrical outlets in the meat department missing moisture/water proof cover?

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Produce Department

  • 1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Deli/Bakery/Sushi

  • 1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?

  • 5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?

  • 6. Any ice buildup on freezer doors, entrances, floors or walls?

  • 7. Are extension cords used in place of installed electric outlets or as permanent wiring?

  • 8. Are extension cords running through ceilings, doors, walls or under carpets?

  • 9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?

  • 10. Any frayed electrical wiring (usually where the cord enters the plug)?

  • 11. Are appliances or equipment missing ground pin on the electrical plug?

  • 12. Are compress gas cylinders secured to prevent them from falling?

  • 13. Are moisture proof globes/covers in freezers either missing or broken?

  • 14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?

  • 16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?

  • 17. Are fire suppression sprinkler heads blocked by items?

  • 18. Do any fire suppression sprinkler heads have decorations attached with tape?

  • 22. Any broken or missing electrical outlet covers?

  • 23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?

  • 24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?

  • 26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?

  • 27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?

  • 28. Do floor mats lay flat on floor, free of trip hazards?

  • 32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?

  • Are eyewash stations inspected weekly?

  • 34. Any other issues identified?

Closeout

  • Any other issues identified?

  • Additional Comments:

  • Completed By:

  • Verified By:

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